Provider Demographics
NPI:1023392693
Name:BROCK, RAYME MICHAEL (RN)
Entity Type:Individual
Prefix:
First Name:RAYME
Middle Name:MICHAEL
Last Name:BROCK
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2801
Mailing Address - Country:US
Mailing Address - Phone:310-808-8289
Mailing Address - Fax:
Practice Address - Street 1:1045 W REDONDO BEACH BLVD FL 3
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4128
Practice Address - Country:US
Practice Address - Phone:323-241-6730
Practice Address - Fax:323-967-0614
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA586605163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health